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Tag Archives: Hospital

Allergy Injections Provided in Outpatient Clinic of Hospital

Hi everyone!

Can anyone tell me how an allergy clinic should be handled within the outpatient setting of a critial access hospital? Is it possible to provide allergy injections (allergist outside of organziation sends drug, we are just admin) in an ouptatient setting of the hospital if there isn’t a provider within the suite? How does this work within a CAH?

Thanks for any help that you may be able to provide.


Medical Billing and Coding Forum – Critical Access Hospitals (CAH)

Subsequent Hospital Visits & ECMO Daily Management

I have never coded these daily management codes for the ECMO, so can they be billed with the subsequent hospital visits. If so is there any reference material pertaining to this? Any help would be greatly appreciated! 🙂

Medical Billing and Coding Forum – Cardiovascular Thoracic

Medicare overbilled by $41.9M – Mount Sinai Hospital

New York City: According to a recent OIG report, Mount Sinai Hospital failed to comply with Medicare’s billing requirements for 110 outpatient and inpatient claims reviewed by the office of Inspector General for the audit period of January 1st, 2012, through December 31st, 2013.

Read the Full Story Here!

The post Medicare overbilled by $ 41.9M – Mount Sinai Hospital appeared first on The Coding Network.

The Coding Network

Inpatient Hospital Payment Rate Impacted by the Consolidated Appropriations Act, 2016

CMS is currently revising the Inpatient Prospective Payment System (IPPS) FY 2016 Pricer to reflect the new payment calculation requirement.  The amount of the payment with respect to the operating costs of inpatient hospital services of a subsection (d) Puerto Rico hospital for inpatient hospital discharges on or after January 1, 2016, will be based on 0 percent of the applicable Puerto Rico percentage and 100 percent of the applicable Federal percentage. In addition, the IPPS FY 2016 Pricer will include conforming changes to certain FY 2016 IPPS operating rates and factors that result from the application of the new Puerto Rico hospital payment calculation requirement, which are applicable to all IPPS hospital discharges on or after January 1, 2016. We will also incorporate the revised IPPS rates into the Long-Term Care Hospital (LTCH) Pricer, as they are used for certain LTCH claims payments.

To allow sufficient time to develop and test, CMS will implement the IPPS and LTCH Pricers on April 4, 2016. Medicare Administrative Contractors (MACs) will reprocess IPPS inpatient claims from Puerto Rico and all other IPPS hospitals with a discharge date on or after January 1, 2016. The MACs will also reprocess LTCH claims with a discharge date on or after January 1, 2016, due to the impact of this change.  Puerto Rico hospitals (as well as all other IPPS and LTCH hospitals) do not need to take any action. We expect to reprocess claims no later than June 30, 2016.

Coding Ahead

CMS Updates Hospital Compare Star Ratings

Patients and their families look for ways to better understand healthcare choices to help them receive the best treatment possible. With this in mind, the Centers for Medicare & Medicaid Services (CMS) has published Hospital Compare information to help patients, “learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important […]

[Announcement] Hospital IPPS and LTCH PPS Final Rule Policy and Payment Changes for FY 2017

Hospital Discharges

Originally Published in MLN Connects

On August 2, CMS issued a final rule to update FY 2017 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The final rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs, would affect discharges occurring on or after October 1, 2016.

The final increase in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful Electronic Health Record (EHR) users is approximately 0.95 percent. This reflects the projected hospital market basket update of 2.7 percent adjusted by -0.3 percentage point for multi-factor productivity and an additional adjustment of -0.75 percentage point in accordance with the Affordable Care Act. This also reflects a 1.5 percentage point reduction for documentation and coding required by the American Taxpayer Relief Act of 2012 and an increase of approximately 0.8 percentage points to remove the adjustment to offset the estimated costs of the Two Midnight policy and address its effects in FYs 2014, 2015, and 2016.

• In sum, CMS projects that total Medicare spending on inpatient hospital services, including capital, will increase by about $ 746 million in FY 2017
• This projected increase in spending includes an estimated $ 350,000 increase in FY 2017 payments to hospitals located in Puerto Rico under the final policy to make IPPS payments for capital-related costs based solely on the national capital Federal rate

The final rule also includes:

• IPPS rate adjustments for documentation and coding and Two-Midnight Policy Medicare uncompensated care payments
• CMS-1632-F & IFC: Finalization of the extension of the Medicare-Dependent Hospital Program and low-volume hospital adjustment provided by MACRA
• Notification procedures for outpatients receiving observation services
• Hospital-Acquired Condition Reduction Program
• Hospital Readmissions Reduction Program
• Medicare and Medicaid EHR Incentive Programs 
• Hospital IQR Program
• Hospital Value-Based Purchasing Program
• PPS-Exempt Cancer Hospital Quality Reporting Program
• Inpatient Psychiatric Facility Quality Reporting Quality Reporting Program
• LTCH PPS changes
• LTCH Quality Reporting Program

See the full text of this excerpted CMS fact sheet (issued August 2).

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